Taylor G J, Crampton R S, Gibson R S, Stebbins P T, Waldman M T, Beller G A
Am Heart J. 1981 Jul;102(1):16-24. doi: 10.1016/0002-8703(81)90407-5.
The prospectively assessed time course of changes in ventricular repolarization during acute myocardial infarction (AMI) is reported in 32 patients admitted 2.0 +/- 1.8 (SD) hours after AMI onset. The initial corrected QT interval (QTc) upon hospitalization was longer (0.52 +/- 0.07 seconds) in the 14 patients developing ventricular tachycardia (VT) within the first 48 hours as compared to QTc (0.47 +/- 0.03 seconds) in the eight patients with frequent ventricular premature beats (VPBs) and to QTc (0.46 +/- 0.03 seconds) in the 10 patients with infrequent VPBs (p less than 0.001; analysis of variance). By the fifth day after AMI onset, the QTc shortened significantly only in the VT group, suggesting a greater initial abnormality of repolarization in these patients. All 32 patients had coronary angiography, radionuclide ventriculography, and myocardial perfusion scintigraphy before hospital discharge. Significant discriminating factors related to early phase VT in AMI included initially longer QT and QTc intervals, faster heart rate, higher peak serum levels of creatine kinase, acute anterior infarction, angiographically documented proximal stenosis of the left anterior descending coronary artery, and scintigraphic evidence of hypoperfusion of the interventricular septum. Prior infarction, angina pectoris, hypertension, multivessel coronary artery disease, and depressed left ventricular ejection fraction did not provide discrimination among the three different ventricular arrhythmia AMI groups. We conclude that (1) the QT interval is frequently prolonged early in AMI, (2) the initial transiently prolonged ventricular repolarization facilitates and predicts complex ventricular tachyarrhythmias within the first 48 hours of AMI, (3) jeopardized blood supply to the interventricular septum frequently coexists, and (4) therapeutic enhancement of rapid recovery of the ventricular repolarization process merits investigation for prevention of VT in AMI.
本文报告了32例急性心肌梗死（AMI）发病后2.0±1.8（标准差）小时入院患者心室复极变化的前瞻性评估时间进程。与8例频发室性早搏（VPB）患者的QTc（0.47±0.03秒）以及10例偶发VPB患者的QTc（0.46±0.03秒）相比，14例在最初48小时内发生室性心动过速（VT）的患者入院时的初始校正QT间期（QTc）更长（0.52±0.07秒）（方差分析，P<0.001）。到AMI发病后第5天，仅VT组的QTc显著缩短，提示这些患者复极的初始异常更大。所有32例患者在出院前均接受了冠状动脉造影、放射性核素心室造影和心肌灌注闪烁扫描。与AMI早期VT相关的显著鉴别因素包括最初较长的QT和QTc间期、较快的心率、血清肌酸激酶峰值水平较高、急性前壁梗死、血管造影证实的左前降支冠状动脉近端狭窄以及室间隔灌注不足的闪烁扫描证据。既往梗死、心绞痛、高血压、多支冠状动脉疾病和左心室射血分数降低并不能区分三种不同的AMI室性心律失常组。我们得出结论：（1）AMI早期QT间期常延长；（2）初始短暂延长的心室复极促进并预测AMI最初48小时内的复杂性室性心律失常；（3）室间隔血供受损常并存；（4）治疗性促进心室复极过程快速恢复值得研究，以预防AMI中的VT。
